Dermatology Case

Question 1

What is a childhool exanthema?

Answer 1

a skin rash accompanying a disease or fever

Question 2

What are 6 diagnoses that should be in the differential for a child with an exfoliative rash?

Answer 2

viral exanthemas

scarlet fever

thermal burns

pemphigus

kawasaki disease

staph scalded skin syndrome

Question 3

What are two important viral exanthemas?

Answer 3

chicken pox (varicella zoster)

fifth’s disease (parvovivrus) - slapped cheeks

Question 4

What are 3 important bacterial exanthemas?

Answer 4

Group A strep causing scarlet fever or impetigo

Staphylococcus aureus causing scalded skin syndrome

EBV causing mononucleosis

Question 5

WHat is Kawasaki disease?

Answer 5

an autoimmune vasculitis that affects the skin, mucous membranes, blood vessels and heart

you get high fever and rash, red eyes and enlarged lymphs nodes

Question 6

What is scalded skin syndrome caused by?

Answer 6

coagulase positive staphylococci which elaborates efoliatin (an epidermolysin)

Question 7

What does exfoliatin do?

Answer 7

It’s an extracellular toxin that splits the upper epidermis below the granular cell layer

Question 8

Where does the exfoliative rash usually occur in SSSS?

Answer 8

on the face - around the mouth

also on feet and hands

Question 9

Does SSSS come with a fevre?

Answer 9

oddly enough, no

Question 10

How is the diagnosis made? Labs?

Answer 10

Usually based on history, appearance and no recent vaccinations

For the labs, the CRP and ESR would be elevated

platelet count normal

gram stain positive for cocci

the blood or tissue cultures would oncfirm the dianosis later

Question 11

What is the treatment for SSSS?

Answer 11

beta-lactamase resistant penicillin like ampicillinw ith sulbactam or a penicillinase-resistant penicillin like nafcillin

Also isolate them because it’s easy to transmit to others